Apparatus for the mechanical ventilation of a patient



APPARATUS FOR THE MECHANICAL VENTILATION OF A PATIENT Filed June 23,1966 Sheet of 2 t 33 32 I6 29 \M 34 h 1 LB 36 33 compasssso 39 AIR Fig.

INVENTORS Forrest M Bird By Henry L. Pohndort Attorneys July 8, 1969 F.M, BIRD ET AL APPARATUS FOR THE MECHANICAL VENTILATION OF A PATIENTFiled June 23,

Sheet 2 INVENTORS Forrest M Bird By Henry L. Pohndorf Attorneys UnitedStates Patent 3,454,000 APPARATUS FOR THE MECHANICAL VENTILATION OF APATIENT Forrest M. Bird, 212 NW. Cerritos, Palm Springs, Calif. 92262,and Henry L. Pohndorf, 1227 Brewster Drive, El Cerrito, Calif. 94530Filed June 23, 1966, Ser. No. 559,972 Int. Cl. A6111 31/00; A62b 7/02U.S. Cl. 128-28 6 'Claims ABSTRACT OF THE DISCLOSURE Apparatus for theventilation of a patient having a respirator, a patient adapter and apneumatic belt all of which are under the control of the respirator.

pulmonary chemotherapy, it is desirable or necessary to enhance themechanical ventilation particularly in the lower part of the lungs whichnormally is obtained by the respirator. There is, therefore, a need fora new and improved apparatus for the mechanical ventilation of apatient.

In general, it is an object of the present invention to provideapparatus for the mechanical ventilation of a patient which enhances theventilation of the lungs of the patient.

Another object of the invention is to provide apparatus of the abovecharacter which includes a respirator and a pneumatic belt utilized incombination to increase the ventilation to the patient.

Another object of the invention is to provide apparatus of the abovecharacter to reduce functional residual capacity during intermittent orcontinuous mechanical ventilation of the patient with obstructivepulmonary disease.

Another object of the invention is to provide apparatus of the abovecharacter which increases the tendency for venous return during thecontinuous mechanical ventilation of the patient with circulatoryhypovolemia.

Another object of the invention is to provide apparaus of the abovecharacter in which the pneumatic belt cannot be over-inflated.

Another object of the invention is to provide apparatus of the abovecharacter which enhances topical pulmonary chemotherapy.

Another object of the invention is to provide apparatus of the abovecharacter which functions both during the inspiratory and expiratorypattern of the patient.

Another object of the inventon is to provide apparatus of the abovecharacter in which cardiopulmonary treatment is enhanced.

Another object of the invention is to provide apparatus of the abovecharacter which can be readily placed upon and removed from the patient.

Additional objects and features of the invention will appear from thefollowing description in which the preferred embodiments are set forthin detail in conjunction with the accompanying drawings.

Referring to the drawings:

3,454,000 Patented July 8, 1969 FIGURE 1 is an elevational view ofapparatus incorporating the present invention for the mechanicalventilation of a patient for intensive care.

FIGURE 2 is an elevational view of apparatus incorporating the presentinvention for mechanically ventilating a patient for use in topicalpulmonary chemotherapy.

FIGURE 3 is a perspective view of the pneumatic belt which is used inthe apparatus shown in FIGURES 1 and 2.

FIGURE 4 is an enlarged detail view of a portion of the pneumatic beltshown in FIGURE 3.

FIGURE 5 is. an illustration showing the manner in which the pneumaticbelt is normally positioned on the patient.

In general, the apparatus for mechanically ventilating a patientconsists of a respirator which has an inhalation phase and an exhalationphase in its operative cycle. The respirator also includes a controllerhaving :an inlet which is adapted to be connected to a supply of gasunder pressure and an outlet. It also includes a main control valvemeans which is disposed in the controller and is movable between openand closed positions to control the flow of gas from the inlet to theoutlet with the main control valve means being in an open positionduring the inhalation phase of the respirator and in a closed positionduring the exhalation phase of the respirator. The respirator alsoincludes a main conduit having a passage therein and is adapted to beconnected to a patient adapter and also to the outlet of the controller.A pneumatic belt is positioned on the patient and is provided with atleast one expandable bladder. Means is provided for connecting theexpandable bladder to the controller so that the bladder is expanded andcontracted in phase with the respirator.

More in particular, as shown in FIGURE 1 of the drawings, the apparatusfor mechanically ventilating a patient consists of a respirator 11 and apneumatic belt assembly 12. The respirator 11 is connected to an in-linenebulizer 13 and a micro nebulizer 14. It is also con nected to a watertrap 16, an exhaust valve assembly 17 and a patient adapter 18. Therespirator can be of any suitable type, as for example, thepositive-negative phase respirator which is shown in US. Letters Patent3,191,- 596 and marketed under the trademark Mark 8 by the BirdCorporation of Palm Springs, Calif. As disclosed in said US. LettersPatent, such a resiprator is of a type which has an inhalation phase andan exhalation phase in its operative cycle. It includes a controller 21having an inlet 22 which is adapted to be connected to a supply of gasunder pressure. The controller also has a main outlet 23. It includesmain control valve means (not shown) disposed in the controller movablebetween open and closed positions to control the flow of gas from theinlet to the outlet.The main control valve means is in an open positionduring the inhalation phase of the respirator and is in a closedposition during the exhalation phase of the respirator. The respiratoris also provided with an additional outlet 26 which is supplied withpositive pressure during the expiratory phase of the respirator and anoutlet 27 which is provided with positive pressure during theinspiratory phase of the respirator.

The main outlet 23 is connected by a large tube 28 to an inlet 29 of thein-line nebulizer 13. The in-line nebulizer 13 can be of a typedescribed in copending application Ser. No. 447,852, filed Apr. 13,1965, now Patent No. 3,353,536. The in-line nebulizer is provided withan outlet 31 which has the micro nebulizer 14 mounted thereon. The micronebulizer can be of the type described in US. Letters Patent 3,172,406.The micro nebulizer is provided with an inlet 32 which is closed with astopper 33. It is also provided with an outlet 34 which is connected bya large tube 36 to one end of the oval shaped water trap 16. The otherend of the water trap is connected to a large tube .37 which .isconnected to .a patient adapted 18 which in the form shown in FIGURE 1is of the endotracheal type. The water trap 16 is a type well known tothose skilled in .the art and is provided with a drain tube.39. Theoutlet 27 is .connected by a small tube 41 to a T 42 mounted on thein-line nebulizer 13. A small tube 43 :iS also connected to the T 42 andis connected to the exhalation valve assembly 17. The exhalation valveassembly 17 is also connected to the patient adapter 18 by .a large.tube 44.

The outlet 26 is connected by a small tube 46 to the inlet 47 of aventuri assembly 48. The venturi assembly 48 is provided with a pair .ofoutlets 51 and 52 (see FIG- URE 4) which are connected to the pneumatic.belt assembly 12 as hereinafter described.

The pneumatic belt assembly 12 consists of an elongate belt 56 which isformed of a suitable flexible material such as cloth or canvas. Sincethe belt is to be utilized on a patient, it is desirable that the .beltbe relatively porous. As can be .Seen, the belt 5.6 is of .asubstantially uniform width and is of sufficient length so that it canencircle the body of the patient. The belt 56 is formed with a pair ofpockets 57 and 58 which extend in opposite directions from the .centerof the belt. .As can be seen from FIGURE 3, the pockets havesubstantially the same width as the belt and have a length such that thetwo pockets substantially cover the patients chest. Suitable means isprovided for opening and closing the pockets and consists of a zipperclosure 59 for each of the pockets.

Each of the pockets is adapted to receive a bladder 61 of a suitabletype, as for example, a rubber bladder which has a substantiallyrectangular configuration which is adapted to fit in each of the pockets57 and 58 as shown. Each of the bladders is provided with a tube 62formed integral therewith through which the bladder can be inflated anddeflated. Each of the bladders is also provided with a fitting 63 whichi closed with a plug 64 The bladders 61 can be readily inserted throughthe zippered closure 59 provided on the pockets 57 and 58.

Suitable means is provided for securing the belt about the patient whichis also adjustable. As shown in the drawings, such means consists ofVelcro-type fastening mean in which a strip 66 of Velcro eyes is mountedon the inside of o e side of the :belt .56 and a strip v67 carryingVelcro hooks is mounted on the outside of th ot er en f t e b lt. By nggi g e tw strips th belt can be comfortably fastened about the chest ofthe pat ent- The venturi assembly 48 consists of a body 71 which isprovided with ,a venturi-like flow passage 72 extending therethrough andhaving an outwardly flared inlet end 73. The body 71 is provided with.an enlarged outwardly flared portion 71a which accommodates theenlarged inlet end 7,3 f-or the passage .72. The other end of the bodyis provided with a bifurcated portion 7112 which has the nipples 51 and.52. A removable .body 76 in the form .of a cap is threaded onto the endportion 71a and which includes the inlet fitting 47.. A flow passage 77with a reducing taper is provided in the inlet fitting 47 and has its,outlet forming a jet nozzle 78 in axial alignment with the passage 72inthe body 71 so that gases jetting through the passage 77 and out thenozzle 78 will .cause a venturi effect in the passage 72 to aspirate thechamber 79 in the cap 76. The bodyor cap 76 is provided with at leastone vhole 80 to permit atmospheric air .to enter the chamber 79 and theventuri like passageway 72.

Means is provided for supporting the main tubes 36 vand 37 and the Watertrap 16 find consists of a radial rod .81 carr y a fit ng :82 which ismounted up n the inlet pipe support stand 22 and is secured thereto .byset screw 83.

As indicated previously, the apparatus shown in FIG URE 1 isparticularly intended for intensive care. The apparatus shown in FIGURE2 is very similar to that shown in FIGURE 1 ith he e p o t at t is p tiularly intended for topical pulmonary chemotherapy. As also shown inFIGURE 2, the apparatus has been simplified in that the nebulizer 13 andthe micro nebulizer 14 have been omitted as well as has been the watertrap 16. A breathing head 86 which is provided with a patient adapter 87has been substituted for the exhalation valve assembly 17 and thepatient adapter 18. The micro nebulizer 14 has been mounted directlyupon the breathing head 86. The breathing head 86 .can be of a typedescribed in Us. Letters Patent 3,191,596.

Operation and use of the apparatus for the mechanical ventilation of apatient may now be briefly described. Let it be assumed that theapparatus shown in FIGURE 1 is to be utilized for the intensive care ofa patient. The pneumatic belt assembly 12 is generally fitted snuglyaround the patients chest approximately 2-3 inches below the xiphoidprocess (V of the rib cage) so that the bladders 61 of the belt are justbelow the leaves of the diaphragm as shown in FIGURE 5. As shown inFIGURE 5, the tube 46 leading to the venturi assembly 48 should be down(away from the patients head) and the Y formed by the body 71 and thebifurcated portion 71b should be facing upwardly toward the patientshead.

As explained previously, the tube 46 is connected to the respirator 11.The nebulizers 13 and 14 are filled in the proper manner. Thereafter,the respirator 11 is placed in operation and passes through theinhalation phase and the exhalation phase in its operative cycle in amanner well known to those skilled in the art. During the inspiratoryphase, air under positive pressure is supplied through the main largetube 28, through the nebulizer 13 and through the micro nebulizer 14 tothe patient adapter 18 which is in the form of a tracheotomy fitting,and thence to the trachea and lungs of the patient. At the same time,air

under positive pressure is supplied through the line 27 to theexhalation valve 17 to keep the exhalation valve 17 in a closed positionduring the inspiratory phase. During this time, no air under pressure issupplied to the small tube 46 to the pneumatic belt assembly 12.

Upon initiation of the expiratory phase by the respirator 11, thepositive pressure in the line 27 is removed and the exhalation valveassembly 17 is permitted .to open to thereby permit the patient toexhale through the exhalation valve. At the same time, positive pressureis applied through the line 46 which causes a jet of air to pass fromthe nozzle 78 and into the venturi-like passage 72 to create a pQsitivepressure in both of the bladders 61 of the pneumatic belt assembly. Thejet of air passing through the venturi-like passage 72 serves toaspirate atmospheric air through opening into the passage 72 to inflatethe bladders 61. During the exhalation phase, the bladders 61 are alwaysinflated to a safe pressure by this feature and .are never over-inflatedbecause the aspiration of atmospheric air through the opening 78 intothe passage will continue until a predetermined positive pressure isreached in the bladders 61. Over-pressures are eliminated because only.a certain pressure will be produced by the jet of air passing throughthe venturi-like passage 72. In this way, it can be seen that amolecular barrier of gas is provided which builds up against the chestof the patient.

Thus, at the start of expiration, infra-abdominal :pressures aregradually increased by the inflation of the bladders 61 to a preselectedvalue by external pressures applied against the upper abdomen. Theincreased intraabdominal pressure during the expiratory phase serves toincrease tendencies for venous return while concomitantly causing anupward force against the diaphragm. The upward force against thediaphragm elevates intra-thoracic pressure, increasing air flow from thelung, thus serving to reduce functional residual gases within the lung.As soon as the expiratory :phase has been completed, pressure is removedfrom the tube 46 and the venturi-like assembly is deactivated and thebladders 61 are emptied through the ports or openings 78 provided in theventuri assembly 48 to contract the bladders, The gases are againsupplied under positive pressure by the respirator to the patientadapter 18 to increase intra-thoracic pressures by the gas flowing intothe lung under positive pressure. Upon completion of the inspiratoryphase and initiation of the expiratory phase, the same sequence takesplace.

From the foregoing, it can be seen that the apparatus is under thecontrol of the respirator and passes through the inhalation phase andexhalation phase under the control of the respirator. The pneumatic beltassembly 12 operating in conjunction with the respirator 11 serves toincrease the ventilation of the lung of the patient and is particularlysuitable for intensive care. The operation of the embodiment shown inFIGURE 2 is substantially identical to that described in conjunctionwith FIGURE 1 and differs only in that it is provided with a breathinghead assembly which is particularly adapted for topical pulmonarychemotherapy. In all other respects, the mode of operation issubstantially identical to that shown in FIG- URE 1.

The apparatus can be used for reducing functional residual capacityduring the intermittent or continuous mechanical ventilation of apatient with obstructive pulmonary disease. It also can be used forincreasing the tendency for venous return during the continuousmechanical ventilation of a :patient with circulatory hypovolemia.

Although the apparatus has been described in conjunction with arespirator of the positive-negative phase type, the pneumatic beltassembly can be utilized in conjunction with a positive phaserespirator. When such a respirator is used, it is desirable to utilize aparallel booster such as the type described in FIGURE 1 of applicationSer. No. 476,508, filed Aug. 2, 1965. Such a parallel booster could beutilized in conjunction with a respirator of the type described in U.S.letters Patent 3,068,856. When such a respirator is used, the parallelcartridge delivers gas to create negativity duringexpiration. This gas,which is delivered to the negative venturi, is actually positivepressure gas and could be utilized for pressurizing the pneumatic beltassembly 12. during the expiratory phase of the respirator.

It is apparent from the foregoing that we have provided an apparatus formechanical ventilation of a :patient which enhances the ventilation ofthe patient. The pneumatic belt assembly which is utilized is one thatcan be readily attached to the patient.

We claim:

1. In apparatus for mechanically ventilating a patient, a respiratorhaving an inhalation phase and an exhalation phase in its operativecycle, said respirator including a controller having an inlet which isadapted to be connected to a supply of gas under pressure, saidcontroller also having a main outlet and first and second additionaloutlets, main control valve means disposed in said controller andmovable between open and closed positions to control the flow of gasfrom said inlet to said main outlet, said main control valve means beingin an open position during the inhalation phase of the respirator and ina closed position during the exhalation phase of the respirator, saidrespirator including means whereby gas is supplied under positivepressure to said first additional outlet during the inhalation phase andto the second additional outlet during the exhalation phase, a patientadapter, a main conduit having a passage therethrough and connecting thepatient adapter to the main outlet of the controller, an exhalationvalve assembly connected to the patient adapter, means connecting saidfirst additional outlet to said exhalation valve assembly for closingsaid exhalation valve during the inhalation phase, a pneumatic beltadapted to be positioned about the chest of the patient, said pneumaticbelt having at least one expandable bladder, and means connecting theexpandable bladder to the second additional outlet so that the bladderis expanded under the control of the respirator during the exhalationphase and contracts during the inhalation phase of the respirator.

2. Apparatus as in claim 1 wherein said means connecting the expandablebladder to the second additional outlet includes a venturi assembly,said venturi assembly having a venturi-like passage therein meansforming a nozzle for directing a stream of gas through the venturilikepassage, and means permitting atmospheric air to be introduced into theventuri-like passage in addition to the gas being introduced through thenozzle.

3. Apparatus as in claim 2 wherein said means permitting atmospheric airto be introduced into the venturilike pasage comprises a cap-like bodyhaving at least one opening therein which opens to the atmosphere, saidnozzle being mounted in said body.

4. Apparatus as in claim 1 wherein said pneumatic belt is formed with apair of pockets therein and wherein an expandable bladder is disposed ineach of said pockets and wherein both of said bladders are connected tosaid second additional outlet.

5. Apparatus as in claim 1 wherein said. means connecting saidexpandable bladder to the second additional outlet includes means forpreventing overinfiation of the bladder.

6. Apparatus as in claim 1 wherein said belt is formed of a flexiblematerial having a pair of pockets disposed intermediate the ends of thebelt, an inflatable bladder disposed in each of said pockets, said beltalso including means for detachably placing the belt on the patient andwherein said means connecting said inflatable bladder to said secondadditional outlet includes means for connecting both of said bladders tosaid controller so that both of said bladders are expanded andcontracted simultaneously.

References Cited UNITED STATES PATENTS 2,071,215 2/1937 Petersen 128282,169,784 8/1939 Andersen 12830.2 2,436,853 3/ 1948 Coleman 128-30.22,699,163 1/1955 Engstrom 12830.2 3,191,596 6/1965 Bird et a1 128145.53,368,550 2/1968 Glascock 12830.2

FOREIGN PATENTS 762,285 4/ 1934 France.

1,129,643 1/ 1957 France.

CHARLES F. ROSENBAUM, Primary Examiner.

US Cl. X.R.

